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General NPI Number Information
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NPI Number | 1093187999
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Entity Type | Organization
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Legal Business Name | MASON PHYSICAL THERAPY AND WELLNESS CENTER
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Dates
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Enumeration Date | 10/30/2015
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Last Update Date | 05/05/2016
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Provider Practice Location Address
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Address Line | 216 W COLLEGE AVE
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City | MASON
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State | TX
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Zip | 76856-3104
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Country | US
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Telephone | 325-294-4700
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2612
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City | FREDERICKSBURG
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State | TX
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Zip | 78624-1924
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Country | US
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Telephone | 830-329-2819
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CORY WADE ROHLF
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Credential | PT
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Telephone | 830-329-2819
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 1104370
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License Number State | TX
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